We're all metatarsal experts now

Monday 2 January 2006 20.37 EST
First published on Monday 2 January 2006 20.37 EST

Like top-of-the-range Bentleys, giant mansions and model girlfriends, it is coming to seem that no England footballer's career is complete until he has suffered a broken metatarsal. As so often, it was David Beckham who started the trend when he injured one of these before the 2002 World Cup. Since then Gary Neville, Steven Gerrard, Wayne Rooney and now Michael Owen, playing for Newcastle at Tottenham last Saturday, are among those who have been afflicted.

A few years ago everybody in sport had heard of feet, but only a small number had come across metatarsals. Now any self-respecting football writer can discourse on these five thin, strong, long bones connecting the toes to the rest of the foot.

Until the research focus increased in recent times on sportsmen and women, most medical studies involving the metatarsal had centred on the military. Nicola Maffulli, a consultant surgeon who is professor of Trauma and Orthopaedic Surgery at Keele University School of Medicine, points out that the phenomenon of multiple micro- fractures, which collectively turn into something more debilitating, was originally described in soldiers of the Prussian army in the late 19th century, where the mechanism was called "march fractures".

In the world of bones, this is known as an over-use injury (common in endurance running, for instance). "If training loads are such that recovery is not allowed to take place, then these micro-fractures can propagate, until the whole bone is involved," Maffulli says.

The other main type is the acute injury, which appears to be what afflicts Owen. The striker's fifth metatarsal on his right foot has what is known as a "dancer's fracture" because it often accompanies an ankle strain.

According to an article by two doctors in a recent edition of The Physician and Sportsmedicine, Warren Yu and Matthew Shapiro, it typically takes between three to four weeks before the pain of a broken fifth metatarsal begins to wear off and the patient can begin gently exercising the foot. "In most cases the patient will be back to sports within six to eight weeks," they write.

Encouraging news for England and their World Cup chances, but it does not explain why so many of the country's top footballers are suffering broken metatarsals. "There could be a weakness there because of a change in footwear and they are not offering the protection they once did," says Exeter University's Sharon Dixon, an expert on the biomechanical aspects of sports injuries, particularly on the influence of changes in footwear.

The new boots worn by modern players are designed to be feather-light but do not offer so much protection, and the use of blade studs could be contributing to this type of injury as they are sharper than round studs.

Taking together, Dixon believes it could be that "the increased levels of training, the different types of surfaces footballers play on these days, combined with the changes in footwear, are contributing to a weakness that is leading to these injuries."

The England manager, Sven Goran Eriksson, will be hoping that the word metatarsal falls out of vogue between now and the end of the World Cup in Germany.